Joseph R. Martire

Testicular radionuclide angiography and static imaging: anatomy, scintigraphic interpretation, and clinical indications.

Radionuclide testicular angiography and static imaging is an easy, rapidly performed study. Its usefulness in separating acute testicular torsion from acute epididymitis has been confirmed. Increased angiographic perfusion with definition of the testicular and deferential arteries in the spermatic cord and the pudendal artery posteriorly is equated with inflammation. Intense increased vascularity on the blood pool image is seen in abscess and acute inflammation, while cases of tumor and trauma have mild increases. Acute or missed testicular torsion, uncomplicated hydroceles, and spermatoceles show absent vascularity. On the static images, decreased activity is characteristic of the stage and location of the avascular structure, Technical factors are stressed.

Differentiating Stress Fracture From Periostitis

In brief Even in the age of high-technology MRI and CT, the triple-phase bone scan (TPBS) remains an exceptionally useful and accurate tool in evaluating athletic injuries. This is perhaps best seen in active people with overuse injuries of the tibia, femur, or humerus when plain films are negative but bone pain persists. Differentiating periostitis from stress fracture requires analyzing distinctive TPBS appearances and patterns.

Team management of the female athlete triad. Part 2 : Optimal treatment and prevention tactics

Multidisciplinary management of the female athlete triad (disordered eating, amenorrhea, and osteoporosis) is optimal, but what exactly does it entail? With the primary care physician as the point person, the healthcare team addresses the underlying causes of disordered eating through such measures as drawing up a contract for returning to play, resolving nutrition issues, exploring psychotherapy options, and, sometimes, prescribing antidepressants. Hormone replacement therapy and conservative or orthopedic intervention for stress fractures may also be required. Communication among the members of the treatment team is crucial, and athletic trainers especially can provide valuable input. Prevention strategies need to involve education of coaches, teachers, trainers, parents, and others who work closely with female athletes.

Unusual stress fracture of the fifth metatarsal in a basketball player.

Fifth metatarsal stress fractures have been widely discussed in the literature. They are the least common of the metatarsal stress fractures but are historically the most debated and problematic. Like other stress fractures, they result from repetitive episodes of microtrauma that alone do not cause an acute fracture but eventually lead to bone failure. The majority of fifth metatarsal stress fractures occur in the proximal third of the bone at the junction of the metaphysis and diaphysis, with a fracture line running transversely from lateral to medial. Controversy exists concerning the definition and treatment of these fractures at the metaphyseal–diaphyseal junction, which are typically referred to as “Jones’” fractures. In this case report, we describe an oblique stress fracture in the shaft of the fifth metatarsal. This fracture pattern in the fifth metatarsal has not previously been recognized and behaves more like a metatarsal stress fracture than a true Jones fracture.

Team management of the female athlete triad: part 1: what to look for, what to ask.

The female athlete triad of disordered eating, amenorrhea, and osteoporosis affects many active women and girls, especially those in sports that emphasize appearance or leanness. Because of the athletes psychological defense mechanisms and the stigma surrounding disordered eating, physicians may need to ask targeted questions about nutrition habits when assessing a patient who has a stress fracture or amenorrhea, or during preparticipation exams. Carefully worded questions can help. Physical signs and symptoms include unexplained recurrent or stress fracture, dry hair, low body temperature, lanugo, and fatigue. Targeted lab tests to assess nutritional and hormonal status are essential in making a diagnosis that will steer treatment, as are optimal radiologic tests like dual-energy x-ray absorptiometry for assessing bone density.

Recognizing upper-extremity stress lesions

Athletes in sports such as baseball, gymnastics, weight lifting, javelin, and racket sports are susceptible to stress lesions in the bones of the upper extremities. Injuries range from periostitis to bone spurs to stress fractures. Injuries in adolescents typically involve the growth plates, while mid-shaft injuries at the area of muscle insertion are more common in adults. Its especially important to detect these injuries in adolescents because untreated stress lesions at growth plates can have serious consequences. Plain films demonstrate obvious fractures and physeal injuries, but triple-phase bone scans are often needed to define the extent of stress lesions.